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Among those who are cured of hepatitis C virus (HCV), men who have sex with men (MSM) have a far higher rate of reinfection than people who inject drugs (PWID), the National AIDS Treatment Advocacy Project (NATAP) reports. In a study of a German cohort, nearly 10 percent of the MSM who were cured of HCV were reinfected annually, likely through sex with men.

Starting in February 2014, researchers from the German Hepatitis C Cohort (GECCO) enrolled in the cohort people who were treated for hep C with direct-acting antivirals. This analysis, the findings of which were presented at the 2018 Conference on Retroviruses and Opportunistic Infections (CROI) in Boston, excluded individuals who were not cured of hep C and those who stopped making clinic visits.

All told, this analysis included 2,074 people, 65 percent of whom were men. They had an average age of 51. Thirty-seven percent of the cohort contracted HCV through injection drug use, 12 percent were males who contracted the virus through sex with other males, and 61 percent had “other” listed as the mode of transmission. Twenty-three percent of the cohort members were coinfected with HIV.

Forty-one members (2 percent) of the cohort were reinfected with HCV after initially being cured of the virus. The median time between being pronounced cured of the virus (which is confirmed via testing conducted 12 weeks after completing treatment) was 63 weeks and ranged between 16 and 180 weeks. All of those who were reinfected were men. They had a median age of 47. Thirty-four (83 percent) of them were coinfected with HIV.

As for the mode of transmission for the reinfections, 63 percent resulted from sex between males, 24 percent from sex between males and injection drug use, and 12 percent from injection drug use alone.

The analysis included 2,239 cumulative years of follow-up for the cohort as a whole, including a median 28 weeks among the PWID and 73 weeks among the MSM. During that time, 14.1 percent of the MSM were reinfected with HCV as were 0.7 percent of the PWID. This translated to an annual reinfection rate of 1.8 percent overall, including 9.4 percent among the MSM and 0.7 percent among the PWID.